Clinical Pathological Conference---Clinical Pathological Conference---Compound OdontomaCompound Odontoma

Wu Cheng-Hsien, Division of Oral & Maxillofacial Surgery, Department of Dentistry, V.G.H.-Taipei

General Data:General Data:• Name: 高 X X • Chart No.: 2935590-6• Ward No.: B108–16 • Sex: Male• Birthday: 74/02/08 • Marital status: Single• Date of admission: 89/06/19 • Occupation: Student

Chief Complaint:Chief Complaint:

• Refer from LDC for removal of radiopaque lesion over R’t lower mandibular region.

History of Present Illness:History of Present Illness: • According to the statement of this 15 y/o boy, a few

days ago , he went to LDC for regular dental check-up and scaling. The Dr. take the apical film & found this odontoma and suggested him to visit VGH OS OPD for help. So he admitted our ward B108-16 for surgery intervention for odontoma removal under GA.

Past Medical/Dental History:Past Medical/Dental History:• General: DM(-) , HTN(-) , Heart disease (-)• Allergies: food and drug(-)• Trauma: significant injuries (-), blood transfusion (-)

Social and Personal History:Social and Personal History:Tobacco: NilAlcohol: NilBetel quid chewing: Nil

Family History:Family History:

• Family lipoma history , and now there is a lipoma over his right arm.

Review of Systems:Review of Systems:• No specific finding

OMS condition:OMS condition:• Extraoral: No facial asymmetry No LAP• Intraoral: retained deciduous tooth: 83• Pano. Finding: >Impaction:18,28,38,48 >A well-defined radiopaque-radiolucent lesion

with radiolucent encapsulation about 1.5x1.5cm over 42-45 apical area

>33: ectopic eruption

Mixed Radiolucent-Radiopaque Lesions

Entity Predominantgender

Predominantage

Predominantjaw

Predominantregion

Distinguishingfeatures

PCOD F-80% >30 Mandible90%

Tooth-bearing area(ant. mand.)

Vital teeth;circulra; size<1cm; well-defined withRL rim

Cementossi-fyingfibroma

F 20s, 30s Mand.70~80%

Premolar-molar

Circular; 2-5cm; well-defined;solitary

Odontomacompound

M~F 5-20 Maxilla 62% Incisor;canine

RL+RO

Odontomacomplex

F-68% 5-20 Mandible Molars RL+RO( patterless)

Ameloblasticfibroodonto-ma

M-63% 5-20 Max.~mand. Premolar-molar

AOT F:M=2:1 16.5 Maxilla 65% 95% anteriorof jaws65% incanine area

PericoronalRL-75%;often RO foci

COC M~F 47%<31 Max.~mand. 75% anteriorto 1st molar

Viscousyellowaspirate

CEOT M~F 40,41 Mandible68%

1. Mandibu-lar molar2. Maxillarmolar;mandibularpremolar

At least 52%associatedwithuneruptedteeth

Odontoma Odontoma

• General features:General features: Mixed odontogenic tumor; epithelial and mesenchymal origin

A kind of harmatoma • Etiology:Etiology: Result from an extraneous bud of odontogenic epithelial cells

from the dental lamina• Epidemiology:Epidemiology: The most common odontogenic tumor(67%); Compound>

Complex(2:1)> ameloblastic odontoma> ameloblastic fibroodontoma

• Age:Age: Occur in the 2nd decade of life (most common in childen and

young adults)

• Sex:Sex: M~F (68% of the complex type occur in women)

• Site:Site: Compound---incisor-canine area of the maxilla; Complex-- 1st

and 2nd molar of the mandible

• Size: Size: 1-3cm

• Progress: Progress: Non-aggressive

• Symptoms:Symptoms:

Delayed eruption of permanent tooth

Ameloblastic odontoma (AO; Ameloblastic odontoma (AO; odontoameloblastoma)odontoameloblastoma)

• Simultaneous occurence of an ameloblastoma and complex odontoma

• Clinical similarities to both the odontoma (age at time of diagnosis) and ameloblastoma (location, expansion and recurrent rate)

• aggressive; rare; benign• More often in children early in the 2nd decade of life; ♂>♀;

mandible>maxilla• Bony expansion; cortex destruction; teeth displacement; mild

pain

Ameloblastic FibroodontomaAmeloblastic Fibroodontoma

• Contain cords & nests of odontogenic epithelium & some calcified odontogenic tissue in a myxomatous stroma

• benign, well-capsulated• ♂>♀; most often in the first two decades of life• mandible>maxilla; most in the premolar-molar area• pericoronal to an imbedded tooth• radiolucent-->radiolucent-radiopaque• D.D.: COC; AOT; CEOT; odontoma• Management: surgical enucleated